Individual
DR. RANDY WALLACE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1602 ROCK PRAIRIE RD, #430, COLLEGE STATION, TX 77845-8306
(979) 693-0737
(979) 693-7442
Mailing address
1602 ROCK PRAIRIE RD, #430, COLLEGE STATION, TX 77845-8306
(979) 693-0737
(979) 693-7442
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
G3802
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115736401
—
TX
Enumeration date
07/07/2005
Last updated
02/14/2014
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